{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T03:26:15Z","timestamp":1785554775499,"version":"3.56.0"},"reference-count":29,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The JSS Academy of Higher Education and Research (JSSAHER), Mysuru","award":["JSSAHER\/REG\/URG\/54\/2023-24\/7951\/6.10.2023"],"award-info":[{"award-number":["JSSAHER\/REG\/URG\/54\/2023-24\/7951\/6.10.2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n               <jats:title>Objective<\/jats:title>\n               <jats:p>This study aimed to compare the effects of oral pre-operative aceclofenac and supplemental intra-ligamentary mepivacaine and articaine injection on the anaesthetic efficacy of failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis in mandibular molars.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Materials and Methods<\/jats:title>\n               <jats:p>A total of 126 patients who fulfilled the inclusion criteria were selected for the study intervention. The study design was a prospective, randomised, double-blinded clinical trial. Pre-operative medication was administered 15 minutes before the patients received the standard IANB. Subsequently, the endodontic therapy was started. Pain felt at any time during the procedure was recorded on a 170 mm Heft\u2013Parker visual analogue scale (VAS), and a supplemental intra-ligamentary injection was administered. Based on the pre-operative medication and the intra-ligamentary injection received, the patients were categorized into the following four groups: two groups received 4% articaine with 1:100,000 epinephrine as an intra-ligamentary injection with or without aceclofenac as the pre-operative medication (Group 1 and Group 2, respectively), and two other groups received 3% plain mepivacaine with or without aceclofenac (Group 3 and Group 4, respectively). The VAS scores were determined pre-operatively, following access preparation and\/or instrumentation within the dentin, the pulpal space, and the instrumentation of canals. Data were analyzed using Pearson\u2019s chi-square test and independent <jats:italic>t<\/jats:italic>-test. A <jats:italic>p<\/jats:italic>-value &lt;\u00a00.05 was considered statistically significant.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Results<\/jats:title>\n               <jats:p>Concerning the supplemental intra-ligamentary injection, 4% articaine with 1:100,000 epinephrine showed a higher success rate than 3% plain mepivacaine, irrespective of the pre-operative medication used, and the difference was statistically significant (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). In addition, if the supplemental intra-ligamentary injection was complemented with pre-operative medication such as aceclofenac 100 mg, the anaesthetic efficacy improved compared to groups receiving a placebo as pre-operative medication (<jats:italic>p<\/jats:italic>\u00a0&gt;\u00a00.05). The anesthetic efficacies of the four groups were as follows: Group 1 (87.1%) &gt;\u00a0Group 2 (66.7%) &gt;\u00a0Group 3 (60.6%) &gt;\u00a0Group 4 (53.1%).<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Conclusions<\/jats:title>\n               <jats:p>In patients with symptomatic irreversible pulpitis of mandibular molars, an intraligamentary injection of 4% articaine combined with 1:100,000 epinephrine can significantly aid in achieving anesthesia in situations where primary IANB is unsuccessful.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Clinical Relevance<\/jats:title>\n               <jats:p>Mandibular molars with symptomatic irreversible pulpitis are associated with a high anaesthetic failure rate of a single primary IANB injection during endodontic treatment. Adding an oral pre-operative aceclofenac medication and a supplemental intra-ligamentary injection, augments the anaesthetic efficacy in such cases.<\/jats:p>\n            <\/jats:sec>","DOI":"10.7717\/peerj.19293","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T08:13:52Z","timestamp":1746000832000},"page":"e19293","source":"Crossref","is-referenced-by-count":3,"title":["The efficacy of pre-operative oral aceclofenac and intra-ligamentary mepivacaine on the success of failed inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomised, double-blinded clinical trial"],"prefix":"10.7717","volume":"13","author":[{"given":"Susmita","family":"Ghosh","sequence":"first","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Maysore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paras Mull","family":"Gehlot","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Maysore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Jadhav","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, All India Institute of Medical Sciences, Nagpur,  Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annapoorna Ballagere","family":"Mariswamy","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Maysore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karkala Venkappa","family":"Kishan","sequence":"additional","affiliation":[{"name":"Srinivas Institute of Dental Sciences, Department of Conservative Dentistry and Endodontics, Mangaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al Malwi","sequence":"additional","affiliation":[{"name":"Department of Restorative Dental Science, King Khalid University, Abha, Aseer, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahabe Saquib","family":"Abullais","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia"},{"name":"Department of Periodontics, Sharad Pawar Dental College, DMIHER, Sawangi, Maharashtra, 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